Exploring low-cost mesh alternatives for groin hernia repair: a systematic review and meta-analysis of randomized controlled trials

Objective: We aim to perform a systematic review and meta-analysis to analyze the efficacy and safety of low-cost meshes compared to polypropylene meshes for IHR.

Methods: We searched Pubmed, Embase, Cochrane, and Web of Science for randomized controlled trials (RCTs) comparing low-cost and standard meshes for IHR. Low-cost mesh was defined as a material non-designed for medical use. The primary outcomes analyzed were postoperative pain, recurrence, surgical site infection (SSI), seroma, and hematoma rates. Statistical analysis was done using R software.

Results: 8 RCTs were ultimately included in our study with 788 patients, of which 394 (50%) underwent IHR repair with low-cost mesh. Surgical techniques employed were Lichtenstein repair in 7 studies, and laparoscopic totally extraperitoneal (TEP) repair in 1 RCT. No statistically significant differences for both superficial (2.8% vs. 2.8%; RR 0.98; 95%CI 0.4-2.43; P = 0.97; I² = 0%), deep SSI (0% vs. 0.31%; RR 0.33; 95%CI 0.01-7.91; P = 0.5; I² = 0%) and overall SSI (3.6% vs. 4.3%; RR 0.83; 95%CI 0.42-1.66; P = 0.6; I² = 0%) were evidenced. Recurrence rate at 1 year was similar between the groups analyzed (0.66% vs. 0%; RR 2.95; 95%CI 0.31-27.95; P = 0.35; I² = 0%). No differences were found for hematoma (12.6% vs. 12.6%; RR 0.99; 95%CI 0.67-1.47; P = 0.98; I² = 0%) and seroma (1.97% vs. 2.33%; RR 0.83; 95%CI 0.29-2.4; P = 0.73; I² = 0%) rates.

Conclusion: This meta-analysis found similar postoperative complication rates for both low-cost and standard polypropylene meshes following IHR.

Prospero registration: ID CRD42024555273.